Journal
CLINICAL TRANSPLANTATION
Volume 36, Issue 8, Pages -Publisher
WILEY
DOI: 10.1111/ctr.14739
Keywords
acute-on-chronic liver failure; acute liver failure; fulminant hepatitis; liver transplantation; living-donor liver transplantation; newly proposed diagnostic criteria in Japan
Categories
Funding
- Japan Agency for Medical Research and Development [20fk0210035s0503, 20fk0310106h0204, 19fm0208009h0003]
- Ministry of Health, Labour andWelfare, Japan [JP-18K08542]
- Taiju Life SocialWelfare Foundation
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The new diagnostic criteria for ACLF in Japan have shown feasibility in classifying patients undergoing liver transplantation. The presence and severity of ACLF, particularly the presence of multiple organ failures, lead to increased morbidity and mortality after transplantation.
Aim Recently, new diagnostic criteria for acute-on-chronic liver failure (ACLF) were established in Japan. However, there is little evidence regarding the feasibility of classifying patients undergoing living-donor liver transplantation (LDLT). The aim was to re-evaluate the impact of these new diagnostic criteria on ACLF and the severity classification of patients undergoing LDLT. Methods We collected data of 82 recipients who underwent LDLT for liver failure between 1997 and 2020 and reviewed it retrospectively. Results Of the 82 patients with liver failure, 31 (37.8%) were diagnosed with ACLF; Grade 0 (n = 6), Grade 1 (n = 7), Grade 2 (n = 9), and Grade 3 (n = 9). There was no substantial difference in overall survival (OS) and the occurrence of postoperative complications between liver failure patients with and without ACLF. The OS after LDLT was significantly different among the four groups of ACLF patients (P = .036). Interestingly, ACLF Grade 3 patients had substantially lower OS compared to other ACLF groups even after LDLT (P = .006; 5-year OS rates, 33.3% vs. 85.9%). Conclusion Proper use of the new diagnostic criteria for ACLF in Japan demonstrated that the presence and severity of ACLF, especially the presence of multiple organ failures, leads to morbidity and mortality even in an LDLT setting. Considering that the patients with ACLF Grade 3 do not have the favorable outcomes of LDLT, deceased-donor liver transplantation usage, or LDLT before reaching the severity of Grade 3 may be suitable for further research.
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